Impact of culture and policy on organ donation: a comparison between two urban trauma centers in developed nations

Organ donation in trauma victims: A systematic review and meta-analysis

BACKGROUND

Although trauma patients represent a large pool of potential organ donors (PODs), the donor conversion rates (DCRs) in this population are unclear. Our primary objective was to synthesize published evidence on DCRs in trauma patients. As a secondary objective, we investigated factors that affect organ donation (OD) in the trauma population.

METHODS

We searched four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) and gray literature for articles on OD in trauma patients (PROSPERO 2017: CRD42017070388). Articles were excluded if it was not possible to calculate the DCR (actual organ donors divided by PODs). We pooled DCRs and performed subgroups analysis by trauma subpopulation, patients' age, and study publication date.

RESULTS

We identified 27 articles with a total of 123,142 participants. Cohorts ranged in size from 28 to 120,512 patients (median, 132), with most studies performed in the United States. Conversion rates among individual studies ranged from 14.0% to 75.2% (median, 49.3%). All 27 studies were included in the meta-analysis. We found a pooled DCR of 48.1% using the random effects model. There was a high level of heterogeneity between studies (I = 97.4%). Upon subgroup analysis, we found DCRs were higher in head trauma patients compared with traumatic cardiac arrest patients (45.3% vs 20.9%, p < 0.001), in pediatric patients compared with adults (61.0% vs 38.0%, p = 0.018), and in studies published after 2007 compared with those published before (50.8% vs 43.9%, p < 0.001). Few studies assessed for factors associated with OD in trauma patients.

CONCLUSIONS

We found variation in DCRs among trauma patients (range, 14.0-75.2%) and estimated a pooled DCR of 48.1%. Our results are limited by heterogeneity across studies, which may be attributable to differences in study design and population, definitions of a POD, and in the institutional criteria and processes regarding OD.

LEVEL OF EVIDENCE

Systematic reviews and meta-analyses level III.

Family Responses to Donor Designation in Donation Cases: A Longitudinal Study

Context

A 2001 state law reinforced donors' rights by mandating that donor consent be strictly honored. One concern was the potentially negative impact of donor designation notification on donor families.

Objectives

To examine donor families' responses to donor designation.

Design

Descriptive nonexperimental design spanning July 1999 to September 2004.

Setting

State served by organ procurement organization.

Data

Results from surveys completed by 569 donor families, including 162 surveys from designated donor families.

Main Outcome Measures

Previous discussions, designation awareness, information helpful, information stress, awareness of meaning of donation, and comfort with designation decision.

Results

The majority (79%) of designated donor families reported their loved ones had discussed donation with them; of these families, 86% were aware of donor designation, and 83% understood what donation entailed. The majority (75%) thought information about loved ones' donor designation was helpful, and only 8% found it stressful. In contrast, 18% of families of nondesignated donors said being approached about donation was stressful after the law was strengthened. However, over 80% of all donor families were comfortable with the donation decision.

Conclusions

The results fail to support the assumption that donor families perceive donor designation notification as negative and stressful. The majority of designated donor families report relief and reduced stress, compared to families approached for donation. The findings suggest that strengthening donor designation legislation can lead to positive results for donor families and donation recipients.

Attitudes and behavior toward organ donation in Greece

INTRODUCTION

During the two last decades remarkable progress has been made among transplantations in Greece. However, organ donation remains a controversial issue.

PURPOSE

To explore and determine factors associated with differences in willingness to donate organs among Greeks.

METHODS

We administered a survey to 2263 adults living in the region of Thessaloniki. We studied the incidence of registered donors, their awareness on the subject of brain death and organ donation, their willingness to donate and factors that influence donation of their own and their relatives organs, as well as their feelings about such a decision.

RESULTS

The respondents knew the significance of brain death and organ donation; 3.8% were already registered to be donors. Nearly half of them (48.3%) wanted to become a donor and 49.1% would donate organs of their relatives; 55.7% were afraid of the procedure of organ removal to and 58.3% would feel guilt about gifting the organs of a relative. Women were more prone to become donors (odds ratio 1.95) and parents were more likely to be registered as donors (odds ratio 1.84). About 63.7% of Orthodox Christians wished to become donors. Professional and educational levels were not observed to influence attitudes.

CONCLUSIONS

Despite knowledge and willingness regarding organ donation, only a small percentage of Greeks are actually registered to be donors.

Changing defaults in biobank research could save lives too

In an effort to increase the amount of organs available for transplantation, many countries have implemented presumed consent for organ donation. Presuming a wish to contribute to medical advances through biobank research on previously taken tissue samples could similarly improve health and wellbeing. In this article we analyze common arguments for and against presumed consent for organ donation and assess their relevance in the context of biobank research. In spite of obvious differences between biobank research and organ transplantation the cases for implementing presumption of a positive attitude appear quite analogous. It has repeatedly been shown that a majority of the general population supports these projects and selecting informed consent as the default position decreases the amount of organs and samples available and thus reduces the prospect of promoting health. We conclude that instead of presuming that individuals do not wish to contribute to the advancement of healthcare through biobank research on previously taken samples, ethics committees should presume that they do.

Organ donation and utilization in the USA

The processes leading to donor identification, consent, organ procurement, and allocation continue to dominate debates and efforts in the field of transplantation. A considerable shortage of donors remains while the number of patients needing organ transplantation increases. This article reviews the main trends in organ donation practices and procurement patterns from both deceased and living sources in the USA. Although there have been increases in living donation in recent years, 2002 witnessed a much more modest growth of 1%. Absolute declines in living liver and lung donation were also noted in 2002. In 2002, the number of deceased donors increased by only 1.6% (101 donors). Increased donation from deceased donors provides more organs for transplantation than a comparable increase in living donation, because on average 3.6 organs are recovered from each deceased donor. The total number of organs recovered from deceased donors increased by 2.1% (462 organs). Poor organ quality continued to be the major reason given for nonrecovery of consented organs from deceased donors. The kidney is the organ most likely to be discarded after recovery. Over the past decade the discard rate of recovered kidneys has increased from 6% to 11%. Many of these are expanded criteria donor kidneys.